Effective Use of e-Prescribing in Physician Practices and Pharmacies (District of Columbia)

Project Details - Ended

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Summary:

Electronic prescribing (e-prescribing) is a central focus of efforts to promote health information technology due to its potential to improve patient safety by reducing medication errors. While many public and private sector initiatives to support e-prescribing have been implemented, physician adoption and use remains relatively limited. Research suggests that the availability of e-prescribing system capabilities that have the potential to improve patient safety and provider efficiency vary. In addition, physician practices face barriers to implementing these capabilities effectively and increasing physician use.

In this project, the Center for Studying Health System Change, a non-partisan health policy research organization, conducted research exploring the effective use of e-prescribing in physician practices and pharmacies. This research focused specifically on e-prescribing among users who electronically send or receive prescriptions directly from or to their e-prescribing system, rather than by stand-alone or computer-generated fax.

The main objective of the project was to explore two areas where challenges to successful e-prescribing implementation and use have been identified in previous research: (1) physician use of e-prescribing features that have the potential to yield health care quality benefits but that prior research has shown not to be available or used routinely by significant proportions of e-prescribers; and (2) electronic communication between physician practices and pharmacies.

The project team conducted 114 telephone interviews with 97 organizations, including 24 medical practices, 48 community-based pharmacies, and three mail-order pharmacies. The study explored physician use of third-party information at the point of prescribing including medication histories, formularies, and generic medication alternatives. The researchers also examined how communication between physician practices and pharmacies is affected by e-prescribing.

Most clinicians interviewed had access to formulary information, while slightly more than half had access to medication histories. Despite the availability of this information, many physicians indicated that they did not routinely review it when making prescribing decisions. To increase the use of generic medications, practices typically allow pharmacists to substitute generic medications when brand medications are prescribed. Some of the interviewed practices utilized tools that present generic alternatives to clinicians at the point of prescribing.

In addition, the project team found that there was general satisfaction with the electronic transmission of new prescriptions. However, electronic prescription renewal was conducted less consistently than transmission of new prescriptions, which led to inefficient workarounds for both prescribers and pharmacies. Because of limitations of networks and computer systems, electronic communication between practices and pharmacies was more likely to occur with community pharmacies than with mail-order pharmacies. Pharmacy staff noted that although there was an overall reduction in manual prescription entry, staff frequently had to edit or complete fields, particularly fields for patient instructions and the drug name.

The project team concluded that while some of the challenges noted might be overcome as physicians and pharmacies become more experienced with e-prescribing, inherent software issues should also be addressed. The study team recommended that a broad group of public stakeholders, including the Federal government, the National Council for Prescription Drug Programs (NCPDP), standards-setting organization, vendors, and medical informatics researchers should work together to address these issues.

Effective Use of e-Prescribing in Physician Practices and Pharmacies - 2011

Summary Highlights

Summary: This project addressed the need for qualitative research about the effects of electronic prescribing (e-prescribing) on physician and pharmacy practice and communication. The potential gains from e-prescribing assume that prescribers and pharmacists have access to and make use of many of the system's available features. Limited research on the topic suggests that not all e-prescribing systems have the full range of features promoted under financial incentive programs established by the Medicare Improvements for Patients and Providers Act of 2008 and the American Recovery and Reinvestment Act of 2009. Further, even when the features are available, physician practices face barriers to implementing them effectively. Features may be implemented at the practice level, but physicians may not choose to use them. To gain the benefits from electronic transmission of prescriptions, both physician practices and pharmacies must routinely use systems enabled for two-way electronic communications. Identified obstacles in both the physician and pharmacy settings include information technology system limitations, workflow and training issues, and real or perceived regulatory barriers.

The Center for Studying Health System Change (HSC), a non-partisan health policy research organization in Washington, D.C., conducted a qualitative study exploring physician use of third-party information (i.e., medication histories, formularies, and generic medication alternatives) at the point of prescribing and physician practice and pharmacy use of electronic routing features. Information collected by the study will inform strategies for governmental and private health care organizations to promote adoption and effective use of e-prescribing capabilities.

Project Objective:

  • Explore how e-prescribing features are implemented and used by physicians and pharmacies with a focus on selected features that have the potential to yield health care quality and cost benefits but that prior research has shown not to be available or used routinely by significant proportions of e-prescribers. (Achieved)

2011 Activities: The focus of activity in 2011 was on developing an HSC research brief titled, "Physician Practices, E-Prescribing and Accessing Information to Improve Prescribing Decisions" published by the HSC in May 2011 and a paper titled, "Transmitting and Processing Electronic Prescriptions: Experiences of Physician Practices and Pharmacies" published by theJournal of American Medical Informatics Association in November 2011.

Impact and Findings: While most of the practices studied reported that physicians had access to patient formulary information, only slightly more than half reported physician access to patient medication histories, and many physicians did not routinely review these sources of information when making prescribing decisions. Study respondents highlighted two primary barriers to use: 1) tools to view and import the data into patient records were cumbersome to use in some systems; and 2) the data were not always perceived as useful enough to warrant the additional time to access and review them, particularly during time-pressed patient visits. To support generic prescribing, practices typically set their system defaults to permit pharmacist substitution of generics; many practices also used other tools to more proactively identify and select generic alternatives at the point of prescribing. Overall, physicians who more strongly perceived the need for third-party data, those in practices with greater access to complete and accurate data, and those with easier-to-use e-prescribing systems were more likely to use these features consistently.

The study team found that practices and pharmacies generally were satisfied with electronic transmission of new prescriptions but reported that the electronic renewal process was used inconsistently, resulting in inefficient workarounds for both parties. Practice communications with mail-order pharmacies were less likely to be electronic than with community pharmacies because of underlying transmission network and computer system limitations. While e-prescribing reduced manual prescription entry, pharmacy staff frequently had to complete or edit certain fields, particularly drug name and patient instructions.

The research team concluded that electronic transmission of new prescriptions has matured but that barriers to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions remain. Similarly, many e-prescribing systems provide electronic access to important information - for example, medications prescribed by physicians in other practices, patient formularies, and generic alternatives - when physicians are deciding what medications to prescribe. However, physician practices with e-prescribing face challenges using these features effectively. Improved data availability and usefulness, changes in technical standards and system design, along with more targeted physician and pharmacy training may be needed to address these barriers.

Target Population: General

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies.

Business Goal: Knowledge Creation

Effective Use of e-Prescribing in Physician Practices and Pharmacies - 2010

Summary Highlights



Target Population: General

Summary: This project addresses the need for qualitative research about the effects of electronic prescribing (e-prescribing) on physician and pharmacy practice and communication. The potential gains from e-prescribing assume that prescribers and pharmacists have access to and make use of the required features. Limited research on the topic suggests that not all e-prescribing systems have the full range of features promoted under financial incentive programs established by the Medicare Improvements for Patients and Providers Act of 2008 and the American Recovery and Reinvestment Act of 2009. Further, even when the features are available, physician practices face barriers to implementing them effectively. Even when the features are implemented at the practice level, physicians may not use them. To gain the benefits from electronic transmission of prescriptions, both physician practices and pharmacies must routinely use systems enabled for two-way electronic communications. Several studies have identified obstacles in both the physician and pharmacy settings that include information technology system limitations, workflow and training issues, and real or perceived regulatory barriers.

The Center for Studying Health System Change (HSC), a non-partisan health policy research organization in Washington, D.C., is conducting a qualitative study exploring physician use of third-party information (i.e., medication histories, formularies, and generic medication alternatives) at the point of prescribing and physician practice and pharmacy use of electronic routing features. Information collected by the study will inform strategies for governmental and private health care organizations to promote adoption and effective use of e-prescribing capabilities.

Project Objective:
  • Explore how e-prescribing features are implemented and used by physicians and pharmacies with a focus on selected features that have the potential to yield health care quality and cost benefits but that prior research has shown not to be available or used routinely by significant proportions of e-prescribers. (Ongoing)

2010 Activities: The project team completed data collection during 2010. Approximately 115 interviews were conducted with representatives of physician practices and pharmacies located in twelve nationally representative communities that have been studied longitudinally since the mid-1990s as part of HSC’s Community Tracking Study, as well as with other local and national stakeholder organizations. The purpose of the interviews was to explore the effects of e-prescribing among users who electronically send or receive prescriptions directly to or from their e-prescribing system, rather than by stand-alone or computer-generated fax. Interviews collected information on physician access to and use of third-party information, physician practice and pharmacy use of electronic routing features, facilitators of and barriers to their use, and the effects of e-prescribing on pharmacies ability to process prescriptions and physician practice-pharmacy communications.

Preliminary Impact and Findings: Findings will be made available in two publications: one on physician use of third-party information at the point of prescribing and a second on physician practices’ and pharmacies’ experiences transmitting and processing electronic prescriptions.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies.

Business Goal: Knowledge Creation

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